Thursday, May 17th, 2012
We are just weeks away from one of the most anxiously awaited Supreme Court decisions in U.S. history. By the end of June the Supreme Court is expected to decide whether the Affordable Care Act, also called “Obamacare,” is constitutional. The justices may find the law is constitutional as it is, or that only parts of it are constitutional, or that the whole thing is unconstitutional.
This week Jake Sherman and Jennifer Haberkorn of Politico reported that House Republicans are making plans for the eventual decision, whatever it is. “If the law is upheld, Republicans will take to the floor to tear out its most controversial pieces, such as the individual mandate and requirements that employers provide insurance or face fines,” they write.
If the law is partly or entirely overturned, the House Republicans will submit new bills that would keep popular parts of the bill while leaving out unpopular parts. Popular parts of the bill include the provision that children can stay on their parents’ health care plans until they are 26 years old. Approximately 2.5 million once uninsured young adults now have insurance coverage, thanks to Obamacare.
Another popular provision is the one that requires insurance companies to cover people with pre-existing conditions. Republicans say they want to keep that. However, a Republican law would not include an individual mandate requiring most Americans to acquire health insurance. The individual mandate easily is the most unpopular part of the Affordable Care Act.
The Supreme Court’s decision could have huge effects on American politics and health care. Will the decision impact the presidential campaigns? Pundits think so, but they cannot agree how. The outcome will also impact everyone’s health care, including Medicare and Medicaid recipients. It could have an immediate impact on people with serious health issues, such as mesothelioma cancer.
Sarah Kliff at the Washington Post points out the weakness in the Republican plan. She says that without the unpopular mandate, the popular parts of the bill will be much more expensive, if not impossible. For example, if insurers must sell policies to people with pre-existing conditions, then healthy people will put off buying insurance until they develop a medical problem.
Insurance works well when more people are putting premium money into the insurance pool than are taking claims out of it. Health insurance companies need to sell lots of policies to healthy people in order to be able to offer policies that most people can afford.
“Forcing insurance companies to provide coverage to those with pre-existing conditions—what insurance wonks call ‘guaranteed issue’—would destroy the private insurance market,” writes Avik Roy at Forbes. A guaranteed issue law without the individual mandate would result in a “death spiral in which people only buy insurance after they’ve already fallen ill.”
Even the young adults covered by their parents’ insurance could drive up costs if only sick young adults bother to get coverage.
House Speaker John Boehner, Republican of Ohio, is quoted by Sherman and Haberkorn in Politoco: “If all or part of the law is struck down, we are not going to repeat the Democrats’ mistakes. … We have better ideas on health care — lots of them. We have solutions, of course, for patients with pre-existing conditions and other challenges.” Let’s hope.